Colorado Workflow

Overview

(As always, private pay is generally self-regulating within the confines of state law and regulatory processes. This article focuses on Medicaid billing in the state of Colorado.)

In the state of Colorado, Medicaid billing is fairly straightforward. Billing currently is through the Gainwell portal. Select Medicaid visits are also be required to be sent to the state's default aggregator, Sandata. For Ankota users, that means in addition to our regular EVV services which we provide, we will also deliver your visit data to Sandata to ensure your state's requirements are met. This article will help guide you through this process.

This article covers:

Critical Pathway

For a simple overview of key admin system maintenance, see this overview with linked steps: Colorado Critical Pathway PDF.pdf

Set-up

State Registration

If you are not already enrolled with the state, you will need to do so. For more information on enrolling, click here.

Sandata Registration

Ankota users in Colorado must register with Sandata. This registration will ensure Sandata will accept their data and give providers access to the Sandata log-in. Internally, Ankota users are automatically set up for delivery of EVV visit data to the state as part of implementation.

To register with Sandata, email COCustomerCare@sandata.com; support@sandata.zendesk.com with the following information:

Agency Information:

Agency Name:
Medicaid ID Number:
Contact Name:
Contact Phone Number:
Contact Email:
Authorization to speak to directly to your vendor: YES

Vendor Information:

Vendor: Ankota, LLC
EVV Vendor Contact Name: Sharon Dodge
EVV Vendor Contact Number: 844-4-Ankota, x. 703
EVV Vendor Contact Email: sharon.dodge@ankota.com
EVV Product Name: Ankota EVV

Sandata Requirements

In addition to the standard set-up of adding clients, caregivers, authorizations, care plans, and scheduling visits, Colorado Medicaid providers will want to ensure the following is available in their system:

Company email at the Org. Details level
Client Medicaid ID in the client's Medicaid ID field (even if it is already in the client ID field)
SSN for caregivers (at least the last 5 digits)
Medicaid Provider ID (provide this to Ankota if you have not already)
Copy the caregiver ID into the caregiver code for all active caregivers
- Do not assign a caregiver code to "fake" caregivers, such as Ankota Support
An email for each administrator
Reason codes for manual reason coding as needed in the system (Ankota will add; you will assign manually as needed)

Testing

For Sandata, no state testing processes are required other than the initial Ankota testing process.

Pre-Billing

Successful billing starts at the beginning of the client's creation. The processes below will lead to successful billing.

Client Management
- Setting Authorized Service for Clients (entering authorizations)
- Schedule Visits - Calendar-Based Scheduling (or for those who prefer the classic approach, Creating Visits from Patterns)
Visit Management
- Caregivers complete visits or timesheets are entered manually through the office
- Visits are approved automatically or visits are approved by office
  - More specifically, ensure visits are closed, then review and clear the Visit Approval Dashboard
  - Note that Sandata visits require Reason Codes to be applied as needed in the Visit Approval Dashboard
Error Prevention
- Watch your warnings on the Action Center (for missing auths, primary diagnosis codes, IDs, etc.) and address as needed
- Watch your warnings on the Visit Approval Dashboard and address as needed
- Ensure that name spellings, Medicaid IDs, and DOBs are entered correctly
- Set reason codes as needed during VAD approval

Billing/Payroll Overview

Billing

To bill, perform your usual visit review and billing processes in Ankota. In other words, after ensuring visits are closed, reviewing the Visit Approval Dashboard, calculating billing, and completing draft invoices, you are ready to bill via Gainwell.

Visit records in the State Solution are transmitted nightly. Visits are available for matching in the Gainwell Claims System the day after a visit is recorded and verified. Please be aware that claims must be billed after service has been completed and a visit has been recorded to ensure proper matching. If a visit has been adjusted, those changes will be available for matching in the Gainwell Claims System the day after the adjustment to the visit has been made. For more information directly from the state, click here.

This data is exported when the visit passes screening OR when the visit is approved. (On hold and Needs Action visits are not sent over.)

Remittance Advice Management (835s)

Remittance advice files, or 835s, are provided in response to filing Medicaid claims. Think of these like state receipts of payments. These files can be uploaded to Ankota for an automatic application of payments in the A/R records. For guidance on this process, see the links below.

Process Remittance Advice (Upload 835 "receipts" received from MMIS into Ankota)
Post Manual Payments
Review Billing Reports
- See also: Collections Report, Exceptions Report

Imported Response Files & Data Management

File Management

After you are connected with Sandata, Ankota will provide you decoded, easy-to-read response files. For more information on this process, click the links below.

Correcting Visits

To correct all rejected visits after making the error correction in Ankota,

Review Sandata Response Files
Correct visits as needed
Bill through Gainwell as usual

The short version is that when correcting errors that were identified in the imported response files, the errors generally fall into one of a few categories, each of which is managed differently. The most common groups of errors and the management processes for them are:

For Reason Code Errors,
- pull the imported response file
- review the errors
- search the Visit Approval Dashboard for the visit IDs that were reported as having errors
- correct the reason code and Save
- click the Export button to re-send this individual visit
For missing Clients or Caregivers,
- pull the imported response file
- review the errors
- notify Ankota Support which client or caregiver file was not successfully delivered
- Ankota will re-send the file
- you will then be able to re-send the visits
For wrong visit types, client, caregiver, dates, or times,
- pull the imported response file
- review the errors
- go to the Billing report page
- filter for the visit with the error
- cancel the associated invoice
- unapprove the visit
- make the changes
- reapprove the visit
- re-run billing

For other errors, reach out to Ankota Support for guidance.

Further Details

These additional resources may be of use to Colorado clients:

The Ankota Training Overview, including videos
Daily Adjustments
Manual Visit Entry